Provider Demographics
NPI:1700388667
Name:REYNOSO- MIRANDA, ANA A
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:A
Last Name:REYNOSO- MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1718
Mailing Address - Country:US
Mailing Address - Phone:646-221-1659
Mailing Address - Fax:
Practice Address - Street 1:224 W 35TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2507
Practice Address - Country:US
Practice Address - Phone:646-221-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist